	<? if($statusMsg){ ?><div style="color:red;"><br><strong><?=$statusMsg?></strong></div><br><? } ?>
	<form name="form1" method="post" action="<?=$_SERVER[PHP_SELF].'?'.$_SERVER[QUERY_STRING]?>">
	<table width="100%" border="0" align="center" cellpadding="2" cellspacing="1" bgcolor="#FFFFFF" class="bTable">
	  <tr>
        <td align="right"><?=translate('email')?> </td>
        <td align="left"><input name="umail" type="text" id="umail" value="<? if($_POST['umail']) print $_POST['umail']; else print $res_email; ?>" maxlength="64"></td>
      </tr>
      <tr>
        <td align="right"><?=translate('domain')?> </td>
        <td align="left"><input name="udomain" type="text" id="udomain" value="<?=$_POST['udomain']?>" maxlength="255"></td>
      </tr>
      <tr>
        <td align="right"><?=translate('problem')?></td>
        <td align="left"><select name="uproblem" id="uproblem">
					<? for($i = 0; $i < count($problemsArr); $i++){ ?>
                         <option value="<?=$problemsArr[$i]['problem']?>" <? if($_POST['uproblem'] == $problemsArr[$i]['id']){ ?>selected<? }?>><?=$problemsArr[$i]['problem']?> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</options>
					<? } ?>
        </select></td>
      </tr>
      <tr>
        <td align="right"><?=translate('subject')?> </td>
        <td align="left"><input name="usubject" type="text" id="usubject" value="<?=$_POST['usubject']?>" maxlength="255"></td>
      </tr>
      <tr>
        <td align="right"><?=translate('questions')?>
		</td>
        <td align="left"><textarea name="udescription" cols="40" rows="5" wrap="VIRTUAL" id="udescription"><?=trim($_POST['udescription'])?></textarea></td>
      </tr>
      <tr>
        <td>&nbsp;</td>
        <td align="left"><input type="submit" name="Submit" value="<?=translate('add_ticket')?>">
        </td>
      </tr>
    </table>
    </form>